Issue No. 6, December 2012

Transcription

1 Issue No. 6, December 2012 From the WHO Regional Office for Europe, WHO/Europe Flu Focus is an e-magazine published by the WHO Regional Office for Europe that covers recent developments, research, reports, materials and resources on influenza. Flu Focus provides updates on influenza and spotlights key features that the WHO Regional Office for Europe would like to bring to your attention. It is sent on a regular basis throughout the influenza season (week 40 week 20 in the following year). We hope that you will consider this e-magazine as a channel through which to share information across the Region. Flu Focus welcomes new knowledge and experiences in influenza responses such as your case studies, strategic thinking, supporting material and any other relevant documentation. Please contact influenza@euro.who.int if you wish to submit something for a future issue. This issue of Flu Focus will be available shortly on the WHO Regional Office for Europe web site at in both English and Russian. Этот выпуск Flu Focus будет также вскоре помещен на сайте Европейского регионального бюро ВОЗ: на английском и русском языках. In this issue TOPICAL FEATURES 1. Update on novel coronavirus SURVEILLANCE AND LABORATORY 2. Situation analysis of current influenza season 3. Report: Second annual joint WHO/Europe and ECDC Influenza Surveillance Meeting 4. Subregional influenza surveillance meeting 5. Better Labs for Better Health initiative 6. Training courses to minimize risk in shipping of infectious substances 7. Country missions INFLUENZA VACCINE 8. Flu Awareness Day Updated WHO position paper on seasonal influenza vaccination 1

2 10. WHO/CDC International meeting on influenza vaccine effectiveness PREPAREDNESS AND RESPONSE 11. Pandemic preparedness guidelines and workshop 12. Upcoming release of new textbook: Pandemic Influenza UPCOMING MEETINGS 13. Third annual joint WHO/Europe and ECDC Influenza Surveillance Meeting 14. WHO Consultation on the Composition of Influenza Vaccines for the northern hemisphere OTHER 15. Recent meetings on influenza disease burden and mortality 16. Peer-reviewed publications 17. Useful links and resources Issue No. 6 summary This issue of Flu Focus offers a flu surveillance update on the influenza season and an update on the status of a novel coronavirus identified in September It shares the latest news on influenza-related activities in the European Region, including summaries of expert meetings and WHO country missions. It also provides details of upcoming events and recent publications as well as a list of useful links for further information. We would like to thank the Member States, our WHO collaborating centres, our partner organizations the European Centre for Disease Prevention and Control (ECDC), the United States Centers for Disease Control and Prevention (CDC) and the many experts who contribute to the work of WHO/Europe who made this publication possible. TOPICAL FEATURE 1. Update on novel coronavirus In September 2012, WHO was alerted to the identification of a novel coronavirus in two patients from Saudi Arabia and Qatar who presented with symptoms of severe respiratory disease. Further investigation confirmed a total of 9 cases, 5 of which were fatal, that had occurred in the period April October 2012 in Saudi Arabia, Qatar and Jordan. Characterization of the full genome sequence of the virus indicates that it belongs to a novel species of coronavirus in the genus Betacoronavirus that is distinct from other known coronaviruses and severe acute respiratory syndrome (SARS). On 29 September WHO issued an interim case definition to help countries strengthen health protection measures against the new virus. From 26 November to 3 December, WHO/Europe and ECDC conducted a rapid survey among Member States on the capabilities of national laboratories to detect and confirm novel coronavirus. Survey 2

3 findings are being used to develop laboratory testing guidance and to identify other support needs. The reservoir and mode of transmission of the novel coronavirus are under investigation and WHO continues to monitor the situation. No additional cases have been reported to WHO under the International Health Regulations since November; and there is no evidence so far of person-to-person transmission of the novel coronavirus. Findings of the WHO/Europe-ECDC survey were reported in a Eurosurveillance rapid communication on 6 December 2012 Further information and regular updates can be found on the new Coronavirus page set up on the WHO/Europe web site SURVEILLANCE AND LABORATORY 2. Situation analysis of current influenza season (weeks 40 49/2012) The influenza season is slowly beginning in the WHO European Region. Consultation rates for influenza-like illness and acute respiratory infection in outpatient surveillance are at low levels (see map 2: Intensity) and influenza viruses are being sporadically detected in a number of countries (see map 3: Geographic spread). Since the start of the season, influenza A and influenza B viruses have been detected in equal proportions. Of the influenza A subtyped viruses, both A (H3N2) and A(H1N1)pdm09 are circulating. Influenza positive cases were generally reported by countries in western Europe, with more than half of the positive samples reported by 5 countries. Of the influenza viruses characterized antigenically since week 40/2012 (n=43), all correspond with the viruses recommended by WHO for inclusion in the current northern hemisphere seasonal influenza vaccine. The number of hospitalizations due to severe acute respiratory infection (SARI) is at pre-season levels, with only 8 influenza cases detected out of 1200 tested since week 40/

4 WHO/Europe coordinates influenza surveillance with ECDC. For more detailed information, please see the EuroFlu bulletin and the ECDC Weekly Influenza Surveillance Overview (WISO). An update of the situation will be published later in the season. 3. Report: Outcome of second annual WHO/Europe and ECDC Influenza Surveillance Meeting The report on the second annual joint WHO/Europe and ECDC meeting on influenza surveillance held on 30 May 1 June 2012, in Warsaw, Poland has just been released. The report summarizes the discussions, conclusions and recommendations of the meeting s various working groups, which focused on disease surveillance and mortality monitoring over the previous year and preparations for the influenza season. The next annual joint WHO/Europe and ECDC Influenza Surveillance Meeting will take place on May Meeting report 4. Subregional influenza surveillance meeting Over 70 epidemiologists, virologists and clinicians involved in influenza surveillance from ten newly independent states (NIS), and the hosting country Latvia, met with experts from Denmark, Romania, Spain, the United Kingdom, WHO headquarters and the United States Centers for Disease Control and Prevention (CDC) on September 2012 in Riga, Latvia. Topics included a review of preparations for the influenza season and studies on the burden of influenza, country presentations on national influenza surveillance systems, presentations of severe influenza cases by clinicians from five countries participating in sentinel SARI surveillance and training on designing a national weekly influenza surveillance bulletin. More information 5. Better Labs for Better Health initiative Improving the quality of laboratory services in health care systems is an essential step towards protecting the health of a country s population and strengthening the health care system as a whole. WHO/Europe is leading an initiative to improve laboratory capacity and strengthen biosafety in Kyrgyzstan, Republic of Moldova and Tajikistan, with the dual aims of improving the health systems in these countries and developing a model of laboratory strengthening that can be applied in developing countries throughout the Region and beyond. The Better Labs for Better Health initiative was announced at the 4th Annual Conference of the Biosafety Association for central Asia and the Caucasus (BACAC) held September 2012 in Almaty, Kazakhstan. 4

5 More information 6. Training course to minimize risk in shipping of infectious substances WHO headquarters and WHO/Europe conducted a two-day Infectious Substances Shipping Training (ISST) course in Almaty, Kazakhstan, in September The training in safe packing and transport was aimed at virologists, bacteriologists and laboratory managers and was based on the requirements and standards of the International Air Transport Association (IATA), the International Civil Aviation Organization (ICAO) and the Universal Postal Union (UPU). Successful completion of the course earned participants a 24-month certificate to perform international shipping of infectious substances. Training course in Kazakhstan 7. Country missions Ukraine, August 2012 WHO/Europe undertook a mission to Ukraine with CDC to review the implementation of sentinel and universal surveillance for influenza at polyclinics and hospitals (including case definitions, respiratory sample collections, data collection and laboratory analysis) and to discuss options for improving data exchange and integration of the current systems for influenza with stakeholders at the Ministry of Health, Gromachevskyi Institute, State Sanitary Epidemiological Service and State Sanitary Epidemiological Station. Azerbaijan, October 2012 This mission was conducted to assess progress in the implementation of sentinel surveillance in polyclinics and hospitals as well as in the performance and capacity of the National Influenza Laboratory. Key findings and recommendations for improvement of the influenza surveillance system were presented at the Ministry of Health on the last day of the mission. More information on the mission and Azerbaijan s influenza surveillance system Uzbekistan, October 2012 The mission was conducted to facilitate the initial stage of influenza sentinel surveillance implementation. Participants from three involved sentinel sites were invited for discussion and training at the National Influenza Center. The Deputy Minister of Health was briefed at the end of the mission. Republic of Moldova, November 2012 WHO/Europe undertook a mission to Republic of Moldova with the WHO Collaborating Centre for Reference and Research on Influenza, London, the United Kingdom to evaluate progress of the National Influenza Laboratory in achieving the level of work necessary to meet the National Influenza Centre terms of reference and to become a member of the WHO Global Influenza Surveillance and Response System (GISRS). 5

6 INFLUENZA VACCINE 8. Flu Awareness Day Influenza vaccine uptake levels in the WHO European Region remain well below the WHO target. To promote vaccination in the Region and answer any questions about influenza prevention and treatment, a group of WHO experts hosted a live twitter chat on 1 November This date at the start of the northern hemisphere s influenza season has been designated Flu Awareness Day in the WHO European Region. A feature article on the WHO/Europe home page including a video detailing The 5 things everyone needs to know about flu provided additional sources of information to raise public awareness. Feature article 9. Updated WHO position paper on seasonal influenza vaccine published On 23 November 2012, WHO published a new position paper on influenza vaccination. The position paper was updated to reflect new evidence accumulated since 2005 related to influenza burden and vaccine effectiveness and safety in the elderly, pregnant women, children (6 months 5 years), individuals with underlying medical conditions and health care workers, including new data on the epidemiology of influenza in developing and tropical countries. Based on an extensive literature review, the WHO Strategic Advisory Group of Experts (SAGE) recommended that pregnant women be given high priority in countries considering initiating influenza vaccine programmes or expanding the target groups to receive vaccination. The new recommendations also emphasize the inclusion of children aged 6 59 months in national vaccination programmes for influenza depending on national capacity and resources in addition to the traditional target groups: the elderly, persons with chronic illness, health care workers and residents of institutions for older persons and the disabled. Vaccines against influenza. WHO position paper November 2012 (Available in English, French and soon also in Russian) Meeting of the Strategic Advisory Group of Experts on immunization, April 2012 conclusions and recommendations 10. WHO/CDC International meeting on influenza vaccine effectiveness, 3 4 December 2012, Geneva, Switzerland The objectives of the meeting were to: review recent data from influenza vaccine effectiveness studies; discuss and agree on optimal methodologies for vaccine effectiveness measurements; explore best practices for conducting vaccine effectiveness studies; 6

7 determine critical knowledge gaps in the availability of efficacy or effectiveness data with a particular focus on low and middle-income countries; discuss challenges in communicating influenza vaccine effectiveness and its importance in vaccine policy development and implementation to derive principles that will help partners communicate effectively with key stakeholders. The meeting concluded with a discussion of next steps, which included proposals to review influenza vaccine effectiveness on a global level, identify gaps in existing data, and develop a WHO guidance document on best practices in conducting vaccine effectiveness studies. PREPAREDNESS AND RESPONSE 11. Pandemic preparedness guidelines and workshop A key activity of WHO/Europe in collaboration with ECDC is to provide Member States with guidance in the development of pandemic influenza preparedness strategies. In response to gaps identified following the 2009 pandemic, Member States are reviewing and revising their preparedness plans. WHO/Europe and ECDC are revising existing European guidance for this effort in line with revisions of the WHO global pandemic preparedness and response guidance. As part of this process, WHO/Europe conducted a workshop in Copenhagen, Denmark, on 5 7 December 2012 for countries of the South-eastern Europe Health Network, the newly independent states, Israel, Switzerland and Turkey. Representatives of 23 Member States presented posters on their countries health systems and pandemic preparedness plans, worked in groups to test these plans in the context of two real case studies and exchanged valuable feedback with WHO and ECDC influenza experts. More information on the workshop 12. Upcoming release of new textbook: Pandemic Influenza The second edition of this textbook, which includes a chapter co-authored by WHO/Europe influenza experts Dr Caroline Brown and Michala Hegermann- Lindencrone, is in press and scheduled for release by the end of December The book is written for students in virology, epidemiology, infectious diseases, public health and medical sciences and will be of interest to all those involved in pandemic preparedness. Incorporating major lessons from the pandemic, it covers areas such as influenza epidemiology, virology and immunology, vaccinology, pharmaceutical and public health countermeasures, policy issues, biomathematical 7

8 modelling and ethics. The information is illustrated with case studies in nine countries. Brown, C and Hegermann-Lindencrone, M, Pandemic preparedness in Van-Tam, J and Sellwood, C (eds) (2012) Pandemic Influenza, 2 nd Edition. CABI, Wallingford, United Kingdom. More information and publication notification UPCOMING MEETINGS 13. Third annual joint WHO/Europe and ECDC Influenza Surveillance Meeting This meeting is scheduled to take place in May 2013 and will bring together national influenza focal points from all 53 Member States of the WHO European Region/European Union and EEA Member States, as well as staff from the WHO Collaborating Centre for Reference and Research on Influenza, London, United Kingdom, and international influenza experts. For more information on the meeting please contact influenza@euro.who.int 14. WHO Consultation on the Composition of Influenza Vaccines for the northern hemisphere Twice annually, WHO organizes consultations with an advisory group of experts to analyse influenza virus surveillance data generated by the WHO Global Influenza Surveillance and Response System (GISRS), and issues a recommendation on the composition of the influenza vaccines for the following influenza season. The consultation meeting for the influenza season in the northern hemisphere will take place in Geneva, Switzerland, on February 2013, followed by an Information Meeting on 21 February 2012 with vaccine manufacturers and national vaccine regulatory agencies. As usual, a representative of one National Influenza Centre in the WHO European Region has been invited as an observer to the meeting. OTHER 15. Recent meetings on influenza disease burden and mortality WHO Informal consultation on influenza disease burden 5 6 December 2012, Geneva, Switzerland The purpose of this meeting was to develop a clear strategy for addressing the critical gaps in our understanding of the influenza disease burden. The objectives were to: review the status of the influenza disease burden work globally; evaluate our current knowledge; 8

9 discuss critical needs; discuss next steps for addressing these needs, including coordination mechanisms between WHO and collaborators. WHO will utilize the information gained from these discussions to develop a clear strategy for addressing the critical gaps in our understanding of disease due to influenza. ECDC Influenza mortality workshop December 2012, Statens Serum Institut, Copenhagen, Denmark Twenty European countries collaborate in the European Mortality Monitoring Project, which is coordinated by Denmark s Statens Serum Institut. The 2012 workshop was organized to develop, test and agree on common recommended multivariable models for use in estimating weekly mortality associated with influenza in Europe, while controlling for additional factors such as Respiratory Syncytial Virus (RSV) and meteorological data. As a result of these discussions, a European mortality model for the 2012/13 season will be developed and piloted. More information on the European Mortality Monitoring Project 16. Peer-reviewed publications of WHO/Europe Influenza and other Respiratory Pathogens Programme (IRP) members The IRP team regularly contributes to peer-reviewed articles for medical journals, with the intention of disseminating information about the work done in collaboration with Member States to a wider audience. The following articles published in the past six months were co-authored by IRP members: Palm D, et al. Laboratory capability for molecular detection and confirmation of novel coronavirus in Europe, Nov Euro Surveill. 2012;17(49):pii= Vega, T, et al. Influenza surveillance in Europe: establishing epidemic thresholds by the Moving Epidemic Method. Influenza and Other Respiratory Viruses Aug. 2012; doi: /j x 17. Useful links and resources WHO/Europe has contributed to translation of the following publications into Russian. The WHO Laboratory Assessment Tool (and its annexes) Available to download in Russian and in English The WHO/CDC/CLSI Laboratory Quality Management Training toolkit Available to download in Russian and in English 9

10 WHO/CDC/CLSI Laboratory Quality Management Handbook (translation in progress) Available to download in English and through the WHO book shop as a hard copy in English WHO/Europe Influenza site WHO/Europe Vaccines and immunization site WHO headquarters Immunization, vaccines and biologicals site WHO headquarters Influenza site European Centre for Disease Prevention and Control (ECDC) influenza site ~ Sent to you from the WHO Regional Office for Europe Current and archived issues of Flu Focus are available on the WHO Regional Office for Europe web site at If you have received this e-magazine and wish to add colleagues, partners, associates or friends (or if you wish to unsubscribe), please contact influenza@euro.who.int World Health Organization All rights reserved. 10